Brain Tumor Surgery with the Toronto Open Magnetic Resonance Imaging System: Preliminary Results for 36 Patients and Analysis of Advantages, Disadvantages, and Future Prospects
- 1 April 2000
- journal article
- research article
- Published by Wolters Kluwer Health in Neurosurgery
- Vol. 46 (4), 900-909
- https://doi.org/10.1097/00006123-200004000-00023
Abstract
Frameless navigation systems represent a huge step forward in the surgical treatment of intracranial pathological conditions but lack the ability to provide real-time imaging feedback for assessment of postoperative results, such as catheter positions and the extent of tumor resections. An open magnetic resonance imaging system for intracranial surgery was developed in Toronto, by a multidisciplinary team, to provide real-time intraoperative imaging. The preliminary experience with a 0.2-T, vertical-gap, magnetic resonance imaging system for intraoperative imaging, which was developed at the University of Toronto for the surgical treatment of patients with intracranial lesions, is described. The system is known as the image-guided minimally invasive therapy unit. Between February 1998 and March 1999, 36 procedures were performed, including 21 tumor resections, 12 biopsies, 1 transsphenoidal endoscopic resection, and 2 catheter placements for Ommaya reservoirs. Three complications were observed. All biopsies were successful, and the surgical goals were achieved for all resections. Problems included restricted access resulting from the confines of the magnet and the imaging coil design, difficulties in working in an operating room that is less spacious and familiar, inconsistent image quality, and a lack of nonmagnetic tools that are as effective as standard neurosurgical tools. Advantages included real-time imaging to facilitate surgical planning, to confirm entry into lesions, and to assess the extent of resection and intraoperative and immediate postoperative imaging to confirm the extent of resections, catheter placement, and the absence of postoperative complications. Intraoperative magnetic resonance imaging has great potential as an aid for intracranial surgery, but a number of logistic problems require resolution.Keywords
This publication has 15 references indexed in Scilit:
- Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 casesJournal of Neurosurgery, 1999
- Invited. MR systems for image‐guided therapyJournal of Magnetic Resonance Imaging, 1998
- Endoscopic endonasal transsphenoidal surgery: experience with 50 patientsJournal of Neurosurgery, 1997
- Intraoperative Diagnostic and Interventional Magnetic Resonance Imaging in NeurosurgeryNeurosurgery, 1997
- Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imagingJournal of Neurosurgery, 1996
- Clinical use of a frameless stereotactic arm: results of 325 casesJournal of Neurosurgery, 1995
- Complications of CT-guided stereotactic biopsy of intra-axial brain lesionsJournal of Neurosurgery, 1994
- Early Postoperative Magnetic Resonance Imaging after Resection of Malignant Glioma: Objective Evaluation of Residual Tumor and Its Influence on Regrowth and PrognosisNeurosurgery, 1994
- Supratentorial Low-Grade Astrocytomas in AdultsNeurosurgery, 1993
- Supratentorial Low-Grade Astrocytomas in AdultsNeurosurgery, 1993